Breast Reconstruction

1 in 8 women will develop invasive breast cancer in their lifetime. Fortunately, for most of these women the cancer is diagnosed early enough that they will live a long and healthy life after treating the cancer. There is also a growing number of women having prophylactic or risk reduction mastectomies to reduce their risk for ever developing breast cancer.

The medical oncologists and breast surgeons can prolong your life (by treating your cancer). Dr. Ben Brown can reconstruct your breasts to improve the quality of your life. Breast reconstruction is Dr. Brown’s passion which is why he dedicates a significant portion of his practice to only breast reconstruction.

Dr. Ben Brown offers the most breast reconstruction techniques in the Pensacola area. He is the only plastic surgeon in the area that performs microvascular free tissue transfer (DIEP flaps, PAP flaps, etc.). The breast reconstruction technique and timing best for you depends on your breasts, your cancer and the treatments required to treat your cancer.

Mastectomy Options

Nipple Sparing Mastectomy (NSM)

Nipple Sparing Mastectomy is an option for women who can see the bottom of their breasts when they put their hands above their head. If you cannot see the bottom of your breasts with your hands above your head, you will need a preliminary lift/reduction before your mastectomy to make you a candidate for a nipple sparing mastectomy. A lift/reduction cannot performed at the same time or after a mastectomy.

The 2 main advantages of a nipple-sparing mastectomy are:

The scar is under the breast, like a really long breast augmentation scar.

The nipple is not removed so it does not need to be reconstructed.

Skin Sparing Mastectomy (SSM)

Skin Sparing Mastectomy is an option for all women. This technique removes the nipple & areola with the breast tissue. Only enough skin is left behind to allow reconstruction, the rest of the skin is removed as part of the mastectomy. The disadvantage of this technique is that it places the scar across the front of the breast.

Breast Mound Reconstruction Options

Implant reconstruction

Implant reconstruction is the most common technique used to reconstruct the breast mound. The implant can be saline or silicone. The implant can be placed at the time of the mastectomy – completing the reconstruction in one stage, this is referred to as “direct to implant reconstruction.” More commonly, a tissue expander is placed at the time of the mastectomy.

There are many advantages to placing a tissue expander and performing the reconstruction in 2 stages. The blood flow to the skin of the breast is primarily provided by blood vessels that travel THROUGH the breast tissue. When this breast tissue is removed at the time of the mastectomy – the skin is very vulnerable to dying due to lack of blood flow. The best way to prevent this is to have a breast surgeon who leaves as much fat on the underside of the breast skin as possible.

The second best way to prevent the vulnerable skin from dying is to minimize the pressure on the skin following the procedure. The advantage of placing a tissue expander at the time of the mastectomy is that it can be under-filled, almost empty when placed at the time of the mastectomy. 1 week later, when the skin has acclimated to its reduced blood flow, the tissue expander can be gradually inflated in the office until the desired size is reached. This process generally takes 2-3 months. We then return to the operating for a second procedure where the tissue expander is exchanged for an implant.

At this second procedure Dr. Brown usually performs liposuction and fat transfer to the breasts to help improve the contour and camouflage the implant. This second procedure is performed as an outpatient, takes less than 2 hours and there are no drains. The pain and recovery are minimal because most of the “cutting” was done at the time of the mastectomy.

Flap Reconstruction

Flap reconstruction or autologous tissue reconstruction refers to using your own tissues to reconstruct your breast mound. The most common tissue used is your lower abdominal tissue. The DIEP flap reconstruction involves transplanting your abdominal skin and fat to your chest to reconstruct your breasts. The artery and vein that feed your abdominal skin and fat are hooked up to an artery and vein in your chest under the microscope. It is like performing an organ transplant where the donor and recipient are the same person.

Nipple Reconstruction

For patients who underwent a skin-sparing mastectomy and had their nipple removed, nipple reconstruction is usually the final step in breast reconstruction. You and Dr. Brown will select the appropriate location and size for your nipple reconstruction. Dr. Brown then performs a local tissue rearrangement in the operating room or under numbing medicine in the office. After this, one of Dr. Brown’s aestheticians tattoos the area.

Oncoplastic Breast Reduction / Reconstruction

If you have large, pendulous breasts and you have chosen to treat your cancer using a lumpectomy followed by radiation, Dr. Brown can improve the appearance of your breasts after radiation by performing an oncoplastic breast reduction. An oncoplastic breast reduction is performed at the time of the lumpectomy OR after the lumpectomy but BEFORE radiation. The purpose of this procedure is to fill in the cavity left by the lumpectomy with other breast tissue via a thoughtfully designed breast lift or reduction. An empty breast cavity within the breast can lead to a significant deformity after radiation. Radiation almost kills tissue, but not quite. This almost dead (radiated) tissue is fraught with complications when we try to manipulate and change it. Therefore, the reduction is best performed BEFORE the radiation while the tissues are still healthy enough to heal.

Once you’ve decided to pursue breast reconstruction in the Pensacola area, you want to make sure to find the right plastic surgeon. Dr. Ben Brown is the only plastic surgeon in the region to train at a 6-year integrated plastic surgery program. During his 6-years at Georgetown University, Dr. Brown was mentored by world renown plastic surgeons Drs. Scott Spear and Maurice Nahabedian. Dr. Ben Brown offers the most reconstructive options in the Pensacola area.

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